a clinical study of snehapana matra nirdharan as a poorva ... · asamhata but sneha absent 3...

International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064

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Volume 6 Issue 2, February 2017 www.ijsr.net

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A Clinical Study of Snehapana Matra Nirdharan as aPoorva Karma of Vaman

Dr. Pradeep U. Jane1, Dr. Pooja H. Jaiswal2

1Professor and HOD of Panchakarma Department, R. A. PodarAyu Medical College, Worli Mumbai- 18, Maharashtra, India

2P G Scholar, Panchakarma Department, R. A. PodarAyu Medical College, Worli Mumbai- 18, Maharashtra, India

Abstract: The Snehana (internal oleation) is a major preparatory procedure to be performed before Sodhana (purification). The entire procedure of Sodhana (purification) depends upon the proper mobilization of humors (Doshas) from the periphery (Sakha ) which is tobe achieved with the help of Snehana (Oleation) and Svedana (Sudation therapy).Oleation leads and decides the total outcome of the Bio purification therapy; Hence, standard guidelines are neededfor performing the internal oleation in an effective manner and also foravoiding the inadequate and excess oleation. It is obligatory to start and increase the dose of lipids (Sneha) in appropriate and judicious way considering the biofire(Agni) and nature of bowel habit (Koshtha) of the subject. In this clinical study dose and duration for each individual were decided according to agni and kosthawise. It is concluded that onset of snehapanalakshana varies in individual koshtha wise and samayaksnigdhalakshana found in the individual as per duration mentioned in classics.

Keyword: Snehapana, Sodhana, Agni, Koshtha

1. Introduction

Sodhanarthsnehapana is that kind of snehana therapy which is performed as a preoperative procedure for panchkarma. Sodhana therapy is intended for purification of the body, bywhich accumulated morbid humours responsible for disease are expelled out to produce an ideal environment for proper functioning of body. Emesis and purgation are theBiopurificatory procedures against the normal physiologicalprocesses of the body.Anything against physiologicalactivity of the body is bound to aggravate the VataDosha.Snehahelps inprotecting the body from the negativeonslaught of VataDosha.

In Ayurvedic classics, brief procedures of internal oleation has been told in the form of verse;however, there is no detail and precise explanation about the test dose, patternof increase in dose, assessment of symptoms of adequate oleation (Samyak Snigdha Lakshana),[1]

Currently, the practicing physicians are facing difficulty indeciding the proper dose and duration of oleation. Therefore, two main discussion points in internal oleation are the fixation of dose and duration. It seems that Scholars have considered biofire(Agni) as a technique to fix the dose ofSnehaand bowel habit (Koshtha) to fixthe duration ofoleation.[2]

There is no mention of dose schedule of Snehain classics. Indirect references regarding the fixation of dose ofSnehaare available. Charaka explained this with anillustration that, just as cloth absorbs the water up to itscapacity then drains off. Similarly, the biofireaccording to its strength digests the Snehaand drains off when excess. Here, Chakrapani also supported the Charaka's view of where tostop Snehana.[3] Up to the 12 cent A.D., the physicians are able to assess the biofireand bowel habit and decide how much dose and duration for Snehais required. Afterwards, inthe society, the physician wanted a quick ready reckoner ofinternal oleationschedule, which was fulfilled by Vangasena

for first time in 12 cent. A.D. Vangasena was the first Scholar to describe clearly the three abstract incremental dose schedules as least, medium, and best.[4]

Ghee (medicated or nonmedicated) is given in specific increasing dose pattern for three to seven days, determined by the nature of bowels passed and the digestive power of anindividual.

The careful daily assessment of oleation is very important for deciding further steps like sudation, emesis, orpurgation. Any error in the assessment may lead to complications. The assessment of the outcome of oleationtherapy is done on the basis of the symptoms of adequate oleation described in the classics.

2. Aim & Objectives

Aim To study SnehapanaMatraNirdharan as a Poorva karma ofvaman.

Objectives 1. To study the snehajeeryamana and jeernalakshana. 2. To study the samyakyog of snehapana.

3. Material and Methods

3.1 Selection Criteria

Total 30 patients were examined by randomized, open, uncontrolled, prospective trial, irrespective of sex, religion, education, occupation, economic status.

Inclusion Criteria 1) Age- 16 to 60 years 2) Patients who were indicated for snehapan and vaman.

Paper ID: ART20171196 1756

wise and samayaksnigdhalakshana found in the individual as per duration mentioned in classics.

Snehapana, Sodhana, Agni, Koshtha

that kind of snehana therapy which of snehana therapy which of a preoperative procedure for panchkarma.

intended for purification of the body, of the body, of bywhich accumulated morbid humours responsible for disease for disease for

produce an ideal environment for proper for proper forEmesis and purgation are the

procedures against the normal physiologicalbody.Anything against physiological

bound to aggravate the VataDosha.inprotecting the body from the negative

Ayurvedic classics, brief procedures of internal oleation of internal oleation ofof verse;however, there is no detail

and precise explanation about the test dose, patternof dose, assessment of symptoms of symptoms of of adequate of adequate of

Samyak Snigdha Lakshana),[1]

Currently, the practicing physicians are facing difficulty indeciding the proper dose and duration of oleation. Therefore, of oleation. Therefore, of

for first time in 12 cent. A.D. Vangasena was the first Scholar to describe clearly the three abstract incremental dose schedules as least, medium, and best.[4]

Ghee (medicated or nonmedicated) or nonmedicated) orincreasing dose pattern for three for three forby the nature of bowels passed and the of bowels passed and the ofindividual.

The careful daily assessment of oleation of oleation offor deciding further steps like sudation, emesis, orpurgation. Any error in the assessment may lead assessment of the outcome of the outcome of of oleationtherapy of oleationtherapy ofbasis of the symptoms of the symptoms of of adequate oleation described of adequate oleation described ofclassics.

2. Aim & Objectives

Aim To study SnehapanaMatraNirdharan vaman.

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Exclusion Criteria 1) Patients having hyperlipidemia, neoplastic diseases,

major illness for a long period. 2) Patient with infectious disease, patient having IBS,

Gastric ulcer, ulcerativecolitis, pulmonary and intestinal TB/AIDS/HBsAG.

3.2 Methodology

Drug: Pure Cow’s ghee (patanjali) for snehapana Dose-On the first day of snehapan 30 ml of sneha was given to each individual. According to time taken for snehajeernalakshan on first day, uttammatra of sneha for each individual was calculated. Now day by day equal increment in snehamatra was done till we get uttammatra onlast as per koshtha of individual. Kal-Early in the morning, at sunrise time, after digestion ofprevious meal. Anupan-Koshnajala (Luke warm water) Duration- According to koshtha of individual. No of patients - 30

3.3 Purva Karma of Abhyantara Snehana

Prior to the Snehana therapy, the assessment of Agni and Koshtha was done. In Patient of Samavastha, the Dipana –PachanaChikitsawas carried out.

3.4 Pradhankarma of Snehapana

Administration of Sneha/ Snehaprashanavidhi A person who was treated should had food well digested ofprevious night and empty stomach in the morning. The patient was instructed to take adequate snehamatra inprashastha din after praying the God and after Mangalvachna, Swativachana i.e. Sun would appear on thesummit of the hill at dawn and lighten up the horizon with the golden rays i.e. early morning. The patient should take proper snehamatra which had been prescribed. Patient was advised to consume warm water along with sneha.

Paschatkarma After the consumption of Ghee instruction was given to the patient not to take food until he/she feels hungry. The Snigdha Lakshanas were observed daily and were scored according to the Scoring pattern.

Statistical Test The data obtained were subjected to statistical analysis forlevel of significance by paired ‘t’ test and wilcoxon signedrank test.

3.5 Parameter for Assessment For SamyakSnigdhaLakshanas:

Scoring Pattern

VatanulomanaLakshana Score

UrdhvaVataPravritti with Udgarabahulya and Adhmana 1UrdhwavataPravrtti, YadaKadaUdgara and Adhmana 2

AlpaAdhmana and Udaragaurava 3Vatanuloman and LaghutaAbhava 4

Vatanulomana and UdaraLaghuta 5

Mala Samhati And SnigdhataAssessed by inspection and history taking

Lakshana ScoreAtiSushka & Grathita 1

Susamhata 2Asamhata but sneha absent 3Asamhata but sneha present 4

Kevala Sneha Nissarana 5

TvakSnigdhata/ GatraSnigdhataThis symptom is assessed by drawing line on the skin with

nails or blunt needle and also by applying tissue paper.Lakshana Score

Excessive Dry and Rough Skin 1Rough Skin 2Dry Skin 3Normal Skin 4Oily skin 5

AngaLaghava (According To Kala)Lakshana Score

Absent in all 24 hrs. 1Present after 18-24 hrs. of Snehapana 2Present after 12-17 hrs. of Snehapana 3Present after 6-11 hrs. of Snehapana 4Present after 3-5 hrs. of Snehapana 5

SnehodvegaLakshana Score

AlpaDvesha, still the person can able to take gheewithout forcing. 1

MadhyamaDvesha by tasting, seeing and smelling,person can able to take ghee on forcing 2

BahuDvesha by tasting, seeing and smelling, personcan’t able to take at all 3

Agnidipti: For easy calculation, an understanding of agnidipti factor. One standardized formula was accepted based on dose ofsneha and time taken for digestion.

Agnibala index: = (test dose) x (time taken for digestion) (Given dose)

Lesser the agnibala index (A.B.I) more will be the Agnidipti.

Assessment of Snigdhata Grade

For assessing the SnigdhataGrade on the bases ofSamyakSnigdhaLakshana, an equation was developed asfollows. Total Score of SamyakSnigdhaLakshana is 23.After vigilantly analyzing the Score ofSamyakSnigdhaLakshana, different grades of Snigdhatahad been framed by giving range of score.

Score of SnigdhataGrade: 19-23 Uttama 13-18 Madhyama 6-12 Avara <6 Ayoga

Paper ID: ART20171196 1757

koshtha of individual. of individual. of

3.3 Purva Karma of Abhyantara Snehana

the Snehana therapy, the assessment of Agni and of Agni and of Patient of Samavastha, the Dipana of Samavastha, the Dipana of –

PachanaChikitsawas carried out.

3.4 Pradhankarma of Snehapana

Sneha/ Snehaprashanavidhi A person who was treated should had food well digested ofprevious night and empty stomach in the morning. The

to take adequate snehamatra inprashastha din after praying the God and after Mangalvachna, Swativachana i.e. Sun would appear on the

dawn and lighten up the horizon with the golden rays i.e. early morning. The patient should take proper snehamatra which had been prescribed. Patient was

consume warm water along with sneha.

of Ghee instruction was given of Ghee instruction was given of to the take food until he/she feels hungry. The

s were observed daily and were scored

AngaLaghava (AccordingLakshana

Absent in all 24 hrs.Present after 18-24 hrs. of SnehapanaPresent after 12-17 hrs. of SnehapanaPresent after 6-11 hrs. of SnehapanaPresent after 3-5 hrs. of Snehapana

SnehodvegaLakshana

AlpaDvesha, still the person canwithout forcing.

MadhyamaDvesha by tasting, seeingperson can able to take ghee

BahuDvesha by tasting, seeing andcan’t able to take at

Agnidipti: For easy calculation, an understanding One standardized formula was accepted based sneha and time taken for digestion.


Lesser the agnibala index (A.B.I) more will Lesser the agnibala index (A.B.I) more will Lesser

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4. Observation and Result

Maximum dose given on last day of Snehapana:Last Day Dose No of Pts %

90-180ml 17 56.67181-270ml 10 33.33271-360ml 3 10

SamyakSnigdhaLakshanas observed in 30 patients: Symptoms No of pts %

Vatanulomana 30 100Agnideepti 30 100

Mala Samhati And snigdhata 30 100TvakSnigdhata/ GatraSnigdhata 30 100

AngaLaghava (accordingto Kala) 30 100Snehodvega 26 86.66

Pattern of Samyak Snigdha Laksanas found in 30patients

Initiation ofSymptoms

Mean Per DayI II III IV V VI VII

Vatanulomana 2.33 2.53 3.26 3.68 4.17 4.3 4.75Mala SamhatiAnd snigdhata 1.43 1.53 2.36 2.65 3.41 3.75 4.15

TvakSnigdhata 1.9 2.36 3 3.48 3.96 4 4.28AngaLaghava 1.4 1.96 2.63 3.34 3.72 4 4.4Snehodvega 1.23 1.23 1.33 1.48 1.62 1.95 2.3

Here scoring pattern was framed in such a way that greater the score, more the Snehana.

Agnidipti: For easy calculation, an understanding of agnidipti factor. One standardized formula is accepted based on dose ofsneha and time taken for digestion.

Agnibala index: = (test dose) x (time taken for digestion) (Given dose) Lesser the agnibala index (A.B.I) more will be the Agnidipti

Initiation ofSymptoms

Mean

I Day II Day III Day IV Day V Day VI Day VIIDay

Agnideepti 3.96 3.32 3.02 2.72 2.54 2.07 2.06

Showing Effect on Subjective Parameters of 30 Patients by Wiilcoxon -Matched-Pair -Signed-Rank-Test:

SYMPTOMS Mean S. D S. E P Value

VatanulomanaFirst Day 2.233 0.5683 0.1038

<0.0001Last Day 4.733 0.4498 0.08212Diff -2.500 0.6297 0.1150

Mala SamhatiAnd snigdhata

First Day 1.433 0.5683 0.1038<0.0001Last Day 4.233 0.4302 0.0786

Diff -2.800 0.5509 0.1006

TvakSnigdhata/GatraSnigdhata


Diff -2.400 0.8944 0.1633AngaLaghava(accordingto

Kala)


Diff -2.900 0.8449 0.1543

SnehodvegaFirst Day 1.233 0.4302 0.0785

<0.0001Last Day 2.333 0.6789 0.1240Diff -1.000 0.5872 0.1072

Showing Effect on Objective Parameters of 30 Patients By Paired ‘T’ Test:

Symptoms Mean S. D S. E ‘t’ value P Value

AgnidiptiFirst Day 3.967 1.650 0.3013

10.052 <0.0001Last Day 2.603 1.318 0.2406Diff 1.364 0.7432 0.1357

5. Discussion

The data suggest that all symptoms of adequate oleation donot appear on the same day but as oleation process goes onin the body, the symptoms appear one by one. First of all, gastrointestinal tract becomes oleated, so that normalcy ofVataDoshaand intensity of biofire are observed initially. Furthermore, when oiliness of stool and loose stool signs appear, then it can be concluded that complete oleation ofgastrointestinal tract has occurred. This is also called asgastrointestinal tract oleation (KoshthaSnigdhata) in general. Afterwards, the symptoms like softness of body parts and oiliness of skin appear. This reveals that oleation has reached up to peripheral tissue level. This is called asperipheral tissue oleation (ShakhaSnigdhata). The symptom of aversion to lipids intake suggests that there is no need offurther administration of lipids

Dose pattern for Snehana

Agni Dose per day in mlI II III IV V VI VII

Manda 30 49.5 69 78 94 105 120Sama 30 63.1 96.3 129.4 162.5 188.3 220

Teekshna 30 72.5 115 157 201.6 255 300Vishama 30 62.9 95.8 128.7 163.6 200.5 234.5

Duration for Snehapana: 1) KruraKoshtha – 7 days 2) MriduKoshtha - 3 days 3) MadhyamaKoshtha - 5 days

6. Conclusion

1) Dose and duration in each individual is specific. 2) The onset of snehapanalakshana varies in individual

koshtha wise. 3) Samayaksnigdhalakshana found in the patients as per

duration mentioned in classics.

References

[1] Charaka .Sutrasthana. In: Charaka Samhita, Trikamji Y.,editors. 5th ed. Chapter 13. NewDelhi: RashtriyaSanskritSansthan; 2002. p. 85. Verse no. 58.

[2] Patil Vasant, Anup B. Journal of Research in Ayurveda and Siddha. Vol. 28. New Delhi: CCRAS; 2007. Thakar, Madhav Singh Baghel. Clinical study on standardization of ShodhanarthSnehana; pp. 26–36.

[3] 3.Charaka .Sutrasthana. In: Charaka Samhita, Trikamji Y., editors. 5th ed. Chapter 13. New Delhi: RashtriyaSanskrit Sansthan; 2002. p. 87. Verse no. 96.

[4] Vangasena A. New Delhi: Chowkhmbha Publications;2002. ChikitsasaraSangraha. SnehanaAdhikara.

Paper ID: ART20171196 1758

Mean Per DayII III IV V VI VII

2.33 2.53 3.26 3.68 4.17 4.3 4.75

1.43 1.53 2.36 2.65 3.41 3.75 4.15

2.36 3 3.48 3.96 4 4.281.4 1.96 2.63 3.34 3.72 4 4.4

1.23 1.23 1.33 1.48 1.62 1.95 2.3Here scoring pattern was framed in such a way that greater the score, more the Snehana.

an understanding of agnidipti factor. of agnidipti factor. of standardized formula is accepted based on dose of

sneha and time taken for digestion.


the agnibala index (A.B.I) more will be the Agnidipti

Mean

III Day IV Day V Day VI Day VIIDay

3.02 2.72 2.54 2.07 2.06

Showing Effect on Subjective Parameters of 30 Patients by Wiilcoxon -Matched-Pair -Signed-Rank-Test:

oiliness of skin appear. This reveals that oleation has of skin appear. This reveals that oleation has ofreached up to peripheral tissue level. This peripheral tissue oleation (ShakhaSnigdhataof aversion of aversion of to lipids intake suggests that there further administration of lipids of lipids of

Dose pattern for Snehana

Agni Dose perI II III IV

Manda 30 49.5 69 78Sama 30 63.1 96.3 129.4

Teekshna 30 72.5 115 157Vishama 30 62.9 95.8 128.7

Duration for Snehapana: 1) KruraKoshtKruraKoshtKr hauraKoshthauraKosht – 7 days – 7 days –

2) MriduKoshthaMriduKoshthaMriduKosht - 3 days 3) MadhyamaKoshtha - 5 days

6. Conclusion

1) Dose and duration in each individual 2) The onset of snehapanalakshana varies of snehapanalakshana varies of

koshtha wise. 3) Samayaksnigdhalakshana found

duration mentioned in classics.

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Author Profile

Dr. Pradeep U. Jane is Professor and HOD ofPanchakarma Department, R. A. PodarAyu Medical College, Worli Mumbai- 18, Maharashtra, India

Dr. Pooja H. Jaiswal is P G Scholar, Panchakarma Department, R. A. PodarAyu Medical College, Worli Mumbai- 18, Maharashtra, India

Paper ID: ART20171196 1759

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a clinical study of snehapana matra nirdharan as a poorva ... · asamhata but sneha absent 3...

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